Chennai: Hospital fined Rs 8.38 lakhs on medical negligence

Chennai: 15 years after a hip surgery went wrong at the Bharathi Raja Hospital in Chennai, the hospital has now been ordered by the District consumer disputes redressal forum ( Chennai North) to pay a compensation of Rs 8.38 lakh to the patient.

The case is that of one David Tyagraj, a lawyer who had met with a road accident in year 2000 in Pondicherry, came to Dr Nagappan at Bharathi Raja Hospital, in T.Nagar, Chennai for consultation and treatment. It was alleged that the doctor was negligent in the treatment of the patient by conducting a hip surgery wrongly by using bad quality plates, delaying treatment and also carrying on the procedure without having full knowledge of it. The patient as a result of this is suffering from permanent disability. Other allegations include not having sufficient infrastructure at the hospital, hence referring the patient to another hospital for CT Scan

Dr Nagappa in his defence informed the forum that the patient was kept under observation for two days before the surgery was performed on the third day. The universal method of treatment was adopted, he said, adding that bone grafting was also done. He also stated that a complete hip replacement surgery would not have been possible immediately reports IndiaTV

The doctor also informed that he recommended the patient to consult Dr Madan Mohan Reddy who suggested that the patient should undergo a total hip replacement. However, Nagappan did not give the any reason Tyagaraj why he was asking him to move to another hospital.

On the matter of the inferior plates, Nagappa claimed that he had advised the patient not to walk or put any pressure on his hip but the patient had not heeded his advice or come back for check-ups, but the forum went through a summary of the surgery provided by the hospital to the patient and found that no such suggestions were made.

However, the court rejected the doctors submissions, and remarked that Dr Nagappan consulted a doctor from another hospital, and referred the patient without assigning any reason in the discharge summary for not performing hip replacement. Also, there is nothing on record to show that post-operative care advice was given to the patient who suffered due to a bent metal plate, which needed corrective surgery. “The wait for a period of two to three days to undertake surgery is a clear case of delay,” they concluded.

“Dr Nagappan has no knowledge of treatment of hip replacement and Bharathi Rajaa hospital does not have sufficient infrastructure for conducting such a surgery,” TOI quotes the court as stating.

The forum has now asked directed the hospital to pay Rs 1 lakh as compensation to the complainant, topping it with Rs 6.18 lakh towards medical expenses, another one lakh towards loss of income and Rs 20,000 as litigation fees. If the hospital fails to pay the amount, then they would have to pay the money with 9 per cent interest, according to reports.

Dr. P.C. Rajaram.M.D.,D.R.,Ph.D.,D.Sc.
Regarding the validity of accusation of negligence on the part of the doctor who performed total replacement of the hip joint 15 years ago, quite a number of points requires to be clarified by a through, fair and impartial enquiry by a panel of senior surgeons constituted by the government:
Whether or not the surgeon who operated upon this patient is qualified and trained to perform such surgical procedures and weather he had performed such surgeries successfully previously.
The fact that the doctor has obtained the second opinion in the best interest of the patient from another surgical colleague to decide on the modality of surgical treatment namely (total hip joint replacement) to be given to the patient proves the sincere and commendable initiative, interest and intention to offer the best treatment to his patient. It is highly unfortunate that this action has been misconstrued and termed wrong. The panel should clarify whether taking a second opinion from another medical colleague is normally followed for the better care of the patients.
The time lapse of two or three days taken for preoperative preparation of the patient and investigations and observation of the patient has been misconstrued as intentional delay. This is very unfortunate, unacceptable and highly deplorable. It is crucial that this serious issue has to be clarified by the above panel. With the modern advancements in technology and anesthesiology surgery has been made safe for the patient. But then, it is more important to make the patient safe for surgery. This needs proper and adequate preparation of the patient. The time taken for this is essential and mandatory. This point has to be addressed and reiterated emphatically. In the case of emergency surgery, one cannot afford to loose time and hence expedite and immediate surgery should be performed with only essential investigations. But, in the case of elective surgery, time taken for preparation of the patient is important and will not amount to delay in treatment.
The fact that bone grafting has also been done to consolidate the bone and make the internal fixations strong shows that the surgeon has taken additional measures for satisfactory healing. This point has to be taken into account by the panel to comment on the competency of the surgeon who operated.
The prosthesis as well as other materials used for internal fixations can become loose in due course, not because of poor quality of the material used, but because of inherent patient factors such as osteoporosis, infection or unusual stress and strain on the operated limb which will also contribute to loosening of the materials used for internal fixation, that too after a long time lapse of 15 years. Regarding the quality of the prostheses used, the companies who supplied, and continue to supply them must clarify and prove to the panel members about the quality of the materials supplied by them.
The panel should declare whether referring the patient to another hospital for C.T. exanimation amounts to lack of infrastructure in the hospital. C.T. exanimation of the patient is a diagnostic procedure. It is only usual and customary on the part of many hospitals including those attached to teaching institutions to avail such sophisticated diagnostic facility from another sister institution. Anybody with some knowledge of the cost of such sophisticated equipment such as C.T., M.R.I. and nuclear bone scans will know that all the hospitals cannot and need not invest on all these costly diagnostic equipments, but any hospital can avail such diagnostic facility from another sister institution who has the facility.

In summary, this patient had been offered best of treatment and care, because of which he had done well for fifteen years. And now, certain complications have appeared which usher in normally in due course because of inherent patient factors as already mentioned in (5).
A fair, impartial and professional enquiry by a panel of experienced senior surgeons will shed light on various facts of the case and will help to meet the ends of justice, and also will go to prove that means have justified the ends of justice.

In present era, one has to be clearly conversant with legal procedures. Defence has a right, but only to restrict to relevant questioning. What is relevant or irrelevant can be pleaded on the spot to the judge, but discretion to allow a question lies with judge. We have to rise to new era, corruption in society and judicial system.

LAWYERS ARE NOT INCLUDED IN CONSUMER ACT. WHY?
BECAUSE THEY ARE THE PERSON WHO ARE MAKING LAWS. WHY THEY WOULD COME UNDER SUCH AN ACT? BECAUSE DOCTORS ARE POOR AT FIGHTING IN THE COURT, THERE IS NO VOICE RAISED AGAINST THIS.

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